Provider Demographics
NPI:1093558678
Name:BOLLA, ROBIN JR (OTR, OTD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:BOLLA
Suffix:JR
Gender:M
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 RAINTREE CIR STE 170&180
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4949
Mailing Address - Country:US
Mailing Address - Phone:972-727-1931
Mailing Address - Fax:
Practice Address - Street 1:997 RAINTREE CIR STE 170&180
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4949
Practice Address - Country:US
Practice Address - Phone:972-727-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513738225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist